29D0953581 CLIA NUMBER - INTERMOUNTAIN HEALTHCARE - LA CANADA CARDIOLOGY

Laboratory Demographics

CLIA Number: 29D0953581

Facility Name: INTERMOUNTAIN HEALTHCARE - LA CANADA CARDIOLOGY

Facility Address:
3131 LA CANADA ST STE 140
LAS VEGAS, NV
ZIP 89169
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Facility Phone Number: 702 933-9400

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1992717722

Taxonomy: 207RH0003X - Internal Medicine
An internist doctor of osteopathy that specializes in the treatment of the combination of hematology and oncology disorders. A doctor of osteopathy that is board eligible/certified by the American Osteopathic Board of Internal Medicine WAS able to obtain a Certificate of Special Qualifications in the field of Hematology and Oncology. The Certificate is NO longer offered.

CLIA Record

Field Name	Field Value
CLIA Number	29D0953581
LAB Type	Physician Office
Facility Name	INTERMOUNTAIN HEALTHCARE - LA CANADA CARDIOLOGY
Street	3131 LA CANADA ST STE 140
City	LAS VEGAS
State	NV
ZIP	89169
Phone	702 933-9400
CertificateType	4
CertificateEffectiveDate	11/5/2022
CertificateExpirationDate	11/4/2024
FacilityType	Waiver

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This page was last updated on: 4/23/2024